M. R. Threlkeld1, N. Apelt1, N. Kremer1, S. F. Polites1, M. Troutt1, J. Geller1, K. Burns1, A. Pai1, R. Nagarajan1, A. J. Bondoc1, G. M. Tiao1 1Cincinnati Childrens’s Hospital Medical Center,Pediatric Surgery,Cincinnati, OH, USA
Introduction: Liver transplantation and complex surgical resection of advanced stage hepatoblastoma have equivalent five-year survival. Both modalities are associated with treatments and complications that impact quality of life. The differences in quality of life outcomes between these two treatments has not been studied and could aid in guiding future therapeutic decisions. We sought to compare the quality of life outcomes for long term survivors who underwent transplantation compared to surgical resection for PRETEXT III or IV hepatoblastoma.
Methods: Following approval from our institutional review board, patients with PRETEXT III and IV hepatoblastoma who underwent surgical therapy from 2000-2013 and survived 2 or more years post-operatively were identified. Patients were grouped into transplant or resection by intention to treat based on the primary operation. Informed consent was obtained from patients over 18 years and parents of the surviving patients younger than 18 years. Assent was obtained from children over 8 years old. Age and treatment appropriate Pediatric Quality of Life Inventory 4.0 (PedsQL™) modules were mailed to consenting participants. Parent reports were used for patients 4 years or younger. Both parents and patients reported for patients over 4 years old. Scoring was performed according to the PedsQL module manual.
Results: We identified 70 patients who met inclusion criteria, 29 (41.4%) were deceased or lost to follow up. Of the 41 remaining patients approached, 33 (80.5%) agreed to participate. At least one questionnaire was completed by 28 (84.8%) patients and or parents; 12 of 14 in the resection and 16 of 19 in the transplant group. There was no statistical difference in age at diagnosis, gender, or response rate between groups. The transplant group was older than the resection group with a respective median age of 10.2 (9.3-13.9, IQR) versus 6.4 (5.1-10.5, IQR) years (p=0.03). We found no statistical difference in the scores between transplant and resection or between patient and parent reports where applicable (Table).
Conclusion: We found no difference in the long term quality of life outcome scores in patients primarily treated with liver transplant compared to radical surgical resection. The therapeutic decision to perform transplant as a primary surgery should not be influenced by the concern of decreased quality of life, but rather predictability of an R0 resection.
